Provider Demographics
NPI:1881013597
Name:BIDDICK, EMILY (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:BIDDICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WILLARD AVE
Mailing Address - Street 2:BUILDING 2 SUITE C
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2650
Mailing Address - Country:US
Mailing Address - Phone:860-666-5601
Mailing Address - Fax:860-667-3909
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:4H MEDICAL EDUCATION
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-9973
Practice Address - Fax:860-545-9159
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT56977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program